Childhood, Health and Society in Uganda

Welcome! This blog is dedicated to detailing the experiences of Johns Hopkins University and Makerere University Kampala students as we explore the health and education programs serving children through a 3-week course in Uganda.

Monday, January 26, 2015

Greetings from Uganda! This blog
post comes to you from the back row of a bumpy and breezy bus ride back from
our safari experience at Lake Mburo National Park. Do you see the longhorn cattle up ahead of us?

After passing zebras,
antelope, baboons, water buffalo and this precarious cattle traffic jam, we feel
compelled to ensure you that no animals were harmed in the writing of this blog
post.

Two mornings ago, after a night
of making farewell speeches, dancing, and exchanging gifts, we woke in Kalisizo
town in rural Rakai province to the call of a stubborn rooster. After packing
our bags, navigating a final bucket shower, and taking a last walk through the
compound garden, we prepared to say goodbye to our host families. Throughout
our time in Rakai, the abundantly welcoming culture of our host parents,
brothers and sisters, and extended family facilitated our immersion and
integration into daily life as a rural Ugandan. Understanding the activity of a
rural family provided valuable context for our studies in malaria and childhood
illness, especially in terms of how daily life and perception of medical care
might explain or indicate trends in population health.

To explain a bit about life in
rural Uganda, as seen through our homestay experience, the majority of our
families were subsistence farmers and maintained vibrant gardens with a wide
variety of produce including eggplant, pumpkins, matooke, bananas, wheat,
maize, Irish potatoes, and sugar cane. After chores, which were divided among
the children of the house (ourselves included), and cooking, which was
typically prepared by the women and girls of the household, members of the
family engaged in income generating activity such as harvesting ground nuts,
raising hens, goats, pigs, and cattle, or weaving handicrafts. As residents and
guests, we learned to peel matooke, Irish potatoes and yams, to cut sugarcane,
to weave mats, and to make simple dishes, among other activities. Many of us also
diligently sought vocabulary lessons to retain phrases, songs, or greetings in
Luganda, which was the local language spoken by most of the residents. After beginning each morning washing utensils,
drawing water for bathing, stroking the fire for the first meal preparation of
the day and ending each evening after taking tea with laughter, games, dancing,
and a traditional meal of matooke, rice, beans, or posho, we grew a distinct
appreciation for the hard work of our host families.

Each night at our homestay we slept
under Insecticide Treated Nets (ITNTs) to prevent mosquito stings since female
anopheles mosquitoes, carriers of the malaria plasmodium parasite, are most
likely to sting at night. We noticed, however, that some of our host siblings
and parents slept without nets and explored the topic later with the
Coordinator of Malaria Studies at the Rakai Health Sciences Program (RHSP)
center, Mr. Baghendaghe Enos. He told us that the diagnosis of malaria in most
of the health facilities is done by the use of Rapid Diagnostic Tests (RDTs)
and microscopic examination of the plasmodium parasites in blood samples. During our conversation, the coordinator noted
that 20% of hospital admissions are due to malaria, of those admissions the illness
contributed to 9% of In-Patient Deaths (IPDs). While residents received free
nets through government programs, many would sell their nets or use them for
other purposes such as carrying, sponges or fish nets. Further exploring the
coverage of the bed net intervention, we visited the Kalisizo hospital general
wards and children’s wards and did not find a single net in the ward. After
discussing the situation with a hospital physician, he noted that although the
hospital had bed nets at one point, patients thought the net was theirs to keep
when they were discharged and then took the net with them upon departure from
the ward. The hospital was financially unable to replenish stocks of mosquito
nets, and therefore nets are no longer provided in in-patient wards. Observing
thick bush around the children’s ward, which are potential breeding ground for
mosquitos, and split window screens and frames, which enable mosquito entry to
the ward, we confirmed with agreement of the director of the children’s ward that
it was possible for children to contract malaria in the hospital.

Besides malaria, respiratory
infections – including pneumonia, asthma, and corhizza - are also some of the
most common community diseases. Although immunization service for pneumonia using
the Dip+HepB+Hib vaccine are often offered at the hospital, very few mothers
make it a point to take their children for immunization which predisposes them
to the illnesses. My two year old host sister Zaharah, for example, cried all
day when we arrived. She had a running nose, cough, and had been diagnosed with
pneumonia a few days prior. For Zaharah, it took her mother a few days to
decide to take her to the hospital; however she recovered quickly
thereafter.

On Saturday of our homestay, we
engaged in a service activity to paint the interior of two classrooms at one of
the local primary schools in Kalisizo called Matale Church of Uganda Primary
School. After painting and learning that primary school boarding is more
frequent in Uganda than the US, we found that the dormitories of primary
boarding school are often cramped living quarters that do not meet public
health standards. When we spoke with Mr. Enos, we learned that skin infections
including ringworms and mites in mattress were very common among school-aged
children as a result of the living conditions.

Since we are visiting during the longest
holiday period in the Ugandan school calendar, we had the opportunity to
observe the lifestyle of children while we were visiting the Musana Music
Center and Toruwu in Kampala, as well as during our homestay in Rakai. In both
the urban and rural setting, families seem to have many children (the fertility
rate in Uganda is about 6 children per woman) and children seem to move freely
about the town from one house to another caring for younger siblings and
joining in large groups to play games. Their frequent daily movement, and
cramped living quarters at night, often with more than one child in the same
bed, could contribute to the spread of infectious disease, according to Mr.
Enos. We also thought this may be a potential indicator of why the director of
the children’s ward noted that July, December, and January consistently
registered the largest volume of patients since the months coincide with the
school holiday calendar.

The cramped quarters of the
children’s ward at the Hospital in Kalisizo seemed to our group to potentially
exacerbate the same pattern of infection spread due to the thirty beds in the 30
square meter ward. When asked about challenges that the ward faced in providing
care to patients, the director emphasized a lack of capacity to meet the needs
of the community in terms of the number of staff, pharmaceutical drugs, beds,
and facilities including monitoring devices. The director also noted that their
care and diagnostic process follows clinical guidelines from the World Health
Organization that is outdated and that they consistently have a poor supply of
drugs to manage illnesses aside from common infections. Despite the challenges
faced by the ward, the director seemed optimistic that emphasis on public
sanitation in the community, increased drug supply, and improved access to
monitoring facilities could improve the quality of care that they are capable
of providing to patients.

Friday, January 23, 2015

Before
being a part of this experience, we all had very different ideas of what a
balanced diet should look like relative to the three different countries that
our group members are from and the foods available in each. As we near the
two-week milestone of our time in Uganda our perceptions of “proper nutrition”
have changed.

On our
first full day together we traveled to Owino in Kampala, one of the two major
markets in the city. It was both an overwhelming and enlightening experience.
The market itself is a maze of stalls; so many people both buying and selling
hundreds of products. It was the meat and fish that grabbed our attention most,
even for those who are not focusing on nutrition as a study. There was no
source of refrigeration to be seen as chunks of raw meat where hanging from
stalls and piled on counters. Though it looked relatively fresh, it was unclear
how long it had been out. There was a similar situation with the fish being sold.
While the majority of that available had already been smoked in order to
preserve it, the fish were still left out, allowing them to come into contact
with flies and any other type of insect that may have been living around that
area. These conditions began to bring up questions regarding the impacts of
sanitation on nutrition, among other things.

Our
homestay experience in Rakai highlighted some of the major staple foods of the
Ugandan diet: matooke (mashed/pressed boiled plantains), Irish potatoes, groundnuts,
and rice. Other important foods also include: sweet potatoes, cassava, maize,
and pumpkin. Most meals served in Uganda are generally heavy in carbohydrates
but also do not have added sugar like many of the foods from other countries. Most
of these products are grown at each family’s home with some exceptions.

One
morning we went on individual group outings to different locations near the
Rakai Health Sciences Program (RHSP). We spent this time at Kalisizo Clinic and
had an extremely informative interview with one of the nurses there, Grace
Nambooze, who explained to us how the topic of nutrition is introduced to
patients every day. Although Kalisizo does not have a nutrition department, the
clinic requires all outpatient cases to complete a health education discussion
before they receive care.

She began by explaining the
different levels of malnutrition: mild, moderate, and severe. Severe cases are
typically referred to a different hospital that can specialize in that
treatment, but Rakai has not seen a situation that serious in at least four
years. Principal Nurse Nambooze went on to mention the importance of education of
a balanced diet of proteins, fats, carbohydrates, greens, and minerals out of
local foods that can be easily and affordably obtained by those living in the
area. If food is too expensive or difficult to grow, it is unlikely that many
will be able to buy or cultivate it sustainably. The clinic asks families to
bring samples of their plantations and health care providers offer lessons on
how to prepare nutritious meals.

Principle
Nurse Nambooze also explained factors that can exacerbate malnutrition. Before
speaking with her, we had been under the impression that malnutrition is
largely synonymous with starvation. This is not necessarily the case though. Co-infectious
diseases such as malaria, TB,HIV/AIDS and diarrhea, are those that impact
immune systems. These create dangerous situations in which patients can easily
become malnourished as their bodies are in weakened states trying to fight the
disease and often do not fully utilize nutrients being taken in. TB patients,
for example, experience a loss of appetite. Even if they have food available to
them they will not be taking in the amount that their body needs simply because
they do not want it.

Our
original perceptions, especially in the early days of the homestay, were that
meals here were not as “nutritious” as we had expected. Upon further
reflection, though, the carbohydrate-heavy diet consumed by most Ugandans fits
perfectly with their very active and work-intensive lifestyle. Beginning with some
of the very first meals that we have been served here, it has constantly come
into question whether or not we are really experiencing the “true” Ugandan
diet. The general consensus is that our experience has been of the Ugandan food
but at much higher quantities and with much greater variety than most would have.
This assertion was backed up today when we talked to the youth representative
of the Ugandan parliament who listed malnutrition as the second direst issue
that Ugandans currently face. We look forward to continuing our research here
in urban Kampala in order to get a more holistic picture of this topic.

Uganda has an astonishing maternal and
infant mortality rate. This poignant fact is what ultimately sparked our
group’s interest in maternal health. We chose to research this topic here because
we wanted to further explore the status of maternal health from a public health
perspective. We began our research by hypothesizing about the cause of such
notable statistics, their impact on expecting mothers and their communities,
and discussed possible solutions that could help better the status of maternal
health. To find the answers to our questions, we met with medical professionals
from both urban and rural locations, such as midwives from Kampala and Rakai
District, traditional birth attendants, and OB/GYNs to learn about each of
their unique perspectives regarding maternal health in Uganda. Our hope is that
after synthesizing our findings from these interviews and site visits, this
information will help us illustrate a clearer image of what maternal health is
truly like in Uganda.

During our
trip to Matale in the Rakai district, we were given a wonderful opportunity to
spend five days with a home-stay family. In conjunction with our homestay, we
were also given tours of the Rakai Health Sciences Program and the Kalisizo
Hospital. At the hospital, we were able to interview a knowledgeable midwife
who gave us information on the hospital, its medical professionals, and patients.
We learned about the antenatal care process, which includes HIV testing, full
body examination, and obtaining medications. Additionally, we learned about
what happens during labor and delivery (high concentrations of c-sections), and
post-natal care (follow up visits with the midwife as needed depending on the
birth). After meeting with the midwife, we toured the facility and learned
about some of the practices that take place in the labor rooms (collecting
extra money for “higher quality” care) and observed the overwhelmingly crowded holding
rooms and lack of sanitary equipment necessary for having safe deliveries.

Once we completed our tour, we learned
about other individuals who assist pregnant mothers with giving birth:
traditional birth attendants. These birth attendants use natural remedies and
produce their own medications for patients to use for a variety of illnesses
such as malaria, diarrhea, ulcers, etc. We were fascinated by the idea of a
woman assisting mothers with the delivery of their child simply through natural
methods so we decided to pay one a visit. With the help of Victoria’s host
brother, Moses, we interviewed a birth attendant at her home and were given a
tour of her herbal garden. She explained how she learned her techniques from other
birth attendants and family members, showed us various types of herbs, which
she uses to cure some of the illnesses mentioned above, and described how she
assists between 10-12 mothers per week with giving birth with few tools and
remedies. However, if the delivery has complications, she refers the patient to
the hospital for professional help.

After our trip to Rakai, we returned to
Kampala and visited Mulago Hospital.

Mulago hospital is the largest hospital in Uganda. It is a
national referral hospital divided into two parts: Upper Mulago (old) and Lower
Mulago (new). A midwife gave us a tour of the facility. First, she took us to
the maternal care service reception where pregnant women are received,
registered and then tested for HIV. In addition to this, the mothers are
divided into counseling groups. All of this is done in a single shelter divided
into compartments by desks. Depending on their HIV status, the mothers are then
given private counseling from the doctors. Next, we went to the labor ward,
which is composed of a single room divided into compartments by curtains for
privacy purposes. After birth, the women are taken to the ward for recovery
depending on the post delivery complications of the mother and baby. Next, the
baby is tested for HIV: if the results are positive, the mother is advised to
bring the child for another test. If the results are positive for this as well,
and at 18 months, it is determined that the child has HIV. Once they have been
confirmed as HIV positive, the child is connected to Bayler Uganda for
medication and a follow up. At Mulago there is a follow up room where HIV
positive women are registered for their health and medication free of charge.

Our group led a reflection session on
January 17th. During this discussion, everyone was given an
opportunity to share their most memorable experiences (the good and bad) along
with what they are looking forward to in our last week. A number of students
were excited about the presentations and going to Jinja. Next, we played
“Maternal Health Jeopardy” in our respective research groups and answered
questions regarding ante-natal care, labor and delivery, post-natal care,
traditional birth attendants, and miscellaneous topics from our trip so far. At
the end of the reflection, we had a discussion on maternal health issues in
Uganda and the US, such as abortion, contraception, prostitution, and natural
medicine. Overall, the reflection session was very informative and all of the groups
actively participated.

Within the
past two weeks, our group has gained a greater knowledge of the status of
maternal health in Uganda. Through our home-stay, interviews with health
professionals and traditional birth attendants, and detailed tours of health
institutions, we believe that we are equipped to give an insightful
presentation to our fellow peers and Makerere University staff. After our
presentation and upon completion of this course, we expect to take the
information that we have learned about maternal health in Uganda and apply it
to certain aspects of American maternal health. We think that there are more
similarities than differences between our two countries, as America still
struggles with health disparities that impact expecting mothers of low-income
families and other demographics. We look forward to sharing what we have
learned about maternal health with our communities once we return home.

Thursday, January 15, 2015

Throughout our time in Uganda we have found
several things that have sparked our attention to our topic of Orphans and
Vulnerable Children (OVC) as we traveled around Kampala and later Rakai.As we began our first days touring Kampala,
we were exposed to two great youth programs including Musana Music Centre, a
full brass band that practices frequently.While we are fond of the program’s developmental aspects, we also
noticed haggles of children running after us or around a corner, often without
parental observation. While walking down to the Centre it was concerning to see
a baby squatting on the front porch of a house and defecating while sitting in
it. We were startled by the unsanitary situation of youths throughout the
village. Young children around 5 years old carrying another two year old on
their back seemed to be the norm as kids were looking after each other. We thought this excessive responsibility robbed
the children of their right to play and be a child. However, given the fact
that Ugandan culture seems to emphasize the importance of the family and the community
over the individual, the kids may not see this as a burden but rather as a
natural part of being in a family.

Perhaps one of
the most informative and interesting experiences that allowed us to dive into
our study more in depth, was the time we spent Friday morning with Joseph
Rutaraka, a Rakai Health Sciences Center employee and founder of the Rakai
Orphans Hope Projects (ROHP). Through Joseph’s lecture we learned much more
about Uganda and specifically Rakai related to OVC.There were things that we expected to hear
that contributed to the burden of the issue in Rakai including the high rates
of poverty, abuse, malnourishment, disease and disability. We found that one
common way a child might be orphaned is if their parents cannot support their basic
needs due to economic hardship, shame, or cultural issues.

We were
surprised to find some of the other conditions surrounding a child’s entry into
OVC. It’s shocking to hear of parents having to abandon their children due to
complications in relationships and other controversial topics. Armed conflict
also resulted in OVC whom may have been involved with groups condoning murder
or cannibalism. In Rakai specifically, HIV is the leading cause of orphaned
children. In Uganda there are 2.5 million orphans and of them 1.2 million are
orphaned by HIV/AIDS. We also learned about some of the positive interventions
and programs targeted at OVCs. Compassion International is one of the leading
organizations supporting child programs in Uganda and throughout the world. We
had the opportunity to visit one of the Compassion International sites in Rakai.
The place was beautiful; the church was painted very colorfully with scenes
from the Bible around the outside. As the program directors gave us a tour of
the office, we could hear the children singing gospel songs inside the church
as part of Compassion’s day program.

After opening
our eyes more to the situation and state of orphans in Rakai district, Joseph
shared with us the driving force behind his passion for working with orphans.
At the age of 10, after his parents died of HIV/AIDS, Joseph became the head of
his household and became responsible for his younger siblings. Thankfully,
Joseph and his two siblings were all born HIV-negative, and they were able to
enter a child sponsorship program through Compassion International, which gave
Joseph the opportunity to attend not only primary and secondary school, but
university as well. After university, Joseph moved to Rakai District to do
research at the Rakai Health Sciences Center and has continued supporting ROPH.
We were so honored to hear this story
and though it truly encompassed the success and benefit we so deeply hope
orphans and vulnerable children can achieve.

In conclusion,
the major cause of orphans in Rakai district and Uganda generally is death of
parents as a result of being infected with HIV/AIDS, but it’s a relief to know
that many approaches are being put in place to reduce the incidence of the
disease in Rakai district. For example, the Stylish Living campaign by the
Rakai Health Sciences Center, in which a van is used for “edutainment” (educational
entertainment) and people of both sexes are encouraged and advised to make
better, healthier choices, for example through circumcision, avoiding
multi-sexual partners, use of condoms, and testing to know one’s HIV status. We
were so excited to hear about and see all the efforts on behalf of the local
people of Rakai to improve the lives of its children, particularly those
affected by HIV/AIDS, and feel blessed to have been able to see these
incredible initiatives firsthand!

Sunday, January 11, 2015

Rolling through the dusty roads of
suburban Kampala in the Ugandan school bus, the HIV/AIDs prevention signs
seemed a bit out of place among the open-faced strip malls selling hand-woven
mats and basic cooking supplies.“375
Ugandans contract HIV every day,” one sign read, baffling us American college
students. Several prevention methods have been identified apart from the public
advertisements, each aimed at reducing the incidence of HIV, whether it be
through education, calls to action, or acknowledgement of future circumstances.

We have spent our past few days at
the Rakai Health Sciences Program (RHSP), an HIV research institute in the
Rakai district of Uganda. RHSP does important prevention and research work in
the area. RHSP has been working to stop the spread of the virus since its
appearance in 1982. Rakai is still home to a high infection rate. The overall
rate of infection in Uganda is 7.3%. This rises to 12% in Rakai. Rakai is a
rural district, home to many small farming villages. Through our time here and
with our homestay families, we have seen that educating the community about how
HIV is spread and how to prevent infection has been vital in the fight against
the virus in Rakai.

Health education is
one of the most effective prevention methods RHSP has implemented. RHSP staff
travel to different parts of Rakai to teach better health practices to small
groups of residents. They have found that theater and drama troupes are the
most effective in promoting their educational messages. Men seem to be the
hardest group to reach, but they respond well to the scripted dramatizations of
various HIV health topics. The clinic at RHSP also has a health education
presentation every morning for the patients. Each month focuses on a different
topic such as family planning or condom use. We were lucky enough to be able to
spend some time at the clinic and see one of these presentations firsthand. The
session was greatly attended and informative. A lot of what we learned from the
Dr. Alice was also presented to the attendees.

RHSP’s biggest
innovation in health education, however, has been their “Stylish Living” event.
This fair-style event brings HIV education to the community through dancing,
live performances, and competitive games. They are even able to offer
prevention methods on site. These include male circumcision, family planning
counseling, couples HIV counseling, and HIV testing. The event is highly
attended and considered a huge success. We saw the “Stylish Man Van” firsthand
and all agreed that the event would probably be a fun and educational
experience.

Another strategy towards HIV/AIDS
prevention in Rakai and elsewhere is condom use. Doctor Alice, a health worker
at the clinic narrates, “Free condoms are given to the female attendants to use
in their households but feedback from them shows their husbands or partners
find this inevitable, opting for unprotected sex.” She also adds, “In most
areas in Uganda, certain brands are free of charge, though a lot of youths fear
being noticed picking them up from conspicuous places.” There is a lot of cross
generational sex, during which the adults in respect of “experience” don’t want
to use condoms. In some areas they don’t know the proper use of condoms due to
illiteracy, so they cannot read the public advertisements or educational
material. Most pregnant mothers only learn that they are HIV/AIDS positive when
first tested in the clinic, which is mandatory for every pregnant woman in
Uganda. In this case, they do not want to be noticed and do not disclose this
to anybody, because most fear being pregnant. The challenge is that
implementing the eMTCT(elimination Of
Mother To Child Transmition) strategy could turn out to be ineffective due to
lack of follow up for the identified HIV/AIDS positive cases. The doctor also
thinks interventions like this being passed on billboards would be most
effective in literate urban populations but not in rural areas in Rakai.

Circumcision
is another strategy used to reduce HIV/AIDS. Circumcision reduces the risk of
HIV infection by 60%.The government has strived to get the male population involved
in safe male circumcision through different mobilization channels (drama/film
shows, village meetings, soccer) where different circumcision messages are
passed to the community members. Free circumcision services are also given to
the community members at different health centers. The circumcision rate in
Uganda is low due to different fears and misconceptions. For example, women usually complain that men
no longer meet their sexual demands once circumcised; while others think their
men will have many sexual partners since they believe they are safe from
HIV/AIDS.However, the Rakai health center
has plans and strategies, such as the mobile circumcision camps and the health
campaign, to increase circumcision rates and to reduce the different perceptions
on circumcision.

The first HIV/AIDS
case in Uganda was in Rakai in 1982, and HIV/AIDS was referred to as “slim
disease” since most people with HIV lost a significant amount of weight. Furthermore,
the hospital recorded at least 5 HIV/AIDS cases every day. Increases in
prevalence since the virus’s appearance are attributed to poor attitudes on
condom use, illiteracy (some people can’t interpret the different health
education messages), many sexual partners, and poverty. Poverty can lead people
in the area to become involved in commercial sex. The incidence is much higher
among the truck men, fishermen, and business people who work in bars.

An
important aspect of the public health intervention on HIV is the social balance
between prevention and clinical treatment, and the allocation of funds
dedicated to the cause.A notable
circumstance is location: the balance may be different in the United States as
compared to Uganda.To reiterate, the
prevalence of HIV in Uganda is 7.3 percent, so the government will spend a
larger percentage of time and resources on the intervention as a whole.As to what the balance should be in Uganda,
the answer is largely subjective.Some
people we have spoken to argue that prevention should be the main focus, as it
will eventually lead to less necessity for treatment anyway.On the other hand, some prevention methods
are not effective, so the focus should be on reducing the negative impact on
the lives of those already affected by HIV/AIDs and increasing their lifespan.Dr. Alice told us that clinical treatment is
funded in the Rakai district of Uganda by a grant from the United States, and
other districts by other countries. Luckily, this allows prevention to thrive
as well as treatment. The circumstances in Rakai breed necessity for both
prevention and treatment, which is why both are essential in a society as
riddled with HIV as Uganda.

Tuesday, January 6, 2015

We have just finished our second full day
in Kampala.We arrived Sunday afternoon
after an hour delay in Addis Ababa to find a public health screening and then a
long line for immigration, so it took several hours to get out of the airport.The upshots were that that we saw a cute
monkey and baby in the parking lot and that we arrived at the Ndere Center very
close to dinner time!After quick
introductions between the Hopkins and the Makerere students, we attended
Ndere’s world famous Sunday evening performance and buffet.For many of the Hopkins students this was
their first taste of traditional Ugandan food, although most choose the Ugandan
barbecue over the traditional buffet.The students very much enjoyed the show, which included traditional
music, song and dance from different regions of Uganda as well as neighboring
countries.

Monday we had a chance to sleep in a
little bit before a big breakfast and then a few hours of team building.Then, after lunch, we headed into downtown
Kampala to visit the Owino market.This
also entailed out first experience of Kampala traffic, which allowed us to get
to know one particular block of a main road quite well!The students divided into teams and explored
each section of the market.They had
assigned tasks in each section--from finding a food they had never seen before
and asking how to prepare it, to finding the most expensive artifact.Afterwards we returned to Ndere for
debriefing and dinner.Sunday evening we
were joined by several public health and development professionals who talked
about how they came to be in their current jobs and then took questions from
the students.

Today was another full day, with a
welcome from Dr. David Serwadda (former Dean of the Makerere School of Public Health
and founder of the Rakai Health Sciences Program) over breakfast followed a
visit to the Musana Music Center.After
being welcomed by their brass band, the students spent time discussing topics
that had been generated by the youth from Musana, and then ultimately ended up
sharing songs with their new Ugandan colleagues before lunch. In addition to
youth development through music, the youth there demonstrated what they call a
tippy-tap: a device they have developed that allows one to wash hands after
using the latrine without needing to touch anything.They plan on building more of these and
sharing them their neighbors. Some of the band members took us into their homes. Here is a picture of Jessica, who welcomed us into her home and talked passionately about how much she respects her mother's efforts for the family.

After
lunch we were invited into the homes of a few of the youth. We had the
opportunity to learn more about the lives of youth and youth development in the
Kampala area.We then headed for a visit
to the program Training of Rural Women in Uganda, or TORUWU.We were welcomed by a second brass band and
then had an opportunity to learn about their programs: making wine and crafts,
cultivating mushrooms, handicrafts, sewing, and another brass band.We spent an hour or so playing with
neighborhood children and chatting with the youth before sharing dinner with
TORUWU organizers and participants.Finally, we returned to Ndere for our first reflection session.

During the reflection session students
discussed their struggles with confronting stereotypes about Africa, poverty,
the role of aid, and their perceptions of U.S. and Ugandan culture.Many were surprised at the level of
development they have seen.The TORUWU
project was cited as exemplifying the “triple bottom line” of demonstrating
economic, environmental and social sustainability.Both the Ugandan and American students have
been struck by both similarities and differences between the U.S. and Uganda
and between their cultures.We split up
into 5 teams to discuss public health topics of particular relevance in Uganda:
Orphans and Vulnerable Children, Maternal Health, HIV, Nutrition, and Malaria
and Childhood Illnesses. We ended the evening by hearing each of the theme
teams talk a bit about what they had seen so far related to the five themes. Each
of our next blog posts will be written about each of these five topics as we
see them in more depth.